<p>Concepts Driving Pharmacogenomics Implementation Into Everyday Healthcare</p>

Abstract

Pharmacogenomics (PGx) is often promoted as the domain of precision medicine with the greatest potential to readily impact everyday healthcare. Rapid advances in PGx knowledge derived from extensive basic and clinical research along with decreasing costs of laboratory testing have led to an increased interest in PGx and expectations of imminent clinical translation with substantial clinical impact. However, the implementation of PGx into clinical workflows is neither simple nor straightforward, and comprehensive processes and multidisciplinary collaboration are required. Several national and international institutions have pioneered models for implementing clinical PGx, and these initial models have led to a better understanding of unresolved challenges. In this review, we have categorized and explored the most relevant of these challenges to highlight potential gaps and present possible solutions. We describe the ongoing need for basic and clinical research to drive further developments in evidence-based medicine. Integration into daily clinical workflows introduces new challenges requiring innovative solutions; specifically those related to the electronic health record and embedded clinical decision support. We describe advances in PGx testing and result reporting and describe the critical need for increased standardization in these areas across laboratories. We also explore the complexity of the PGx knowledge required for clinical practice and the need for educational strategies to ensure adequate understanding among members of current and future healthcare teams. Finally, we evaluate knowledge obtained from previous implementation efforts and discuss how to best apply these learnings to future projects. Despite these challenges, the future of precision medicine appears promising due to the rapidity of recent advances in the field and current multidisciplinary efforts to effectively translate PGx to everyday clinical practice.

Implementing Pharmacogenomics Testing: Single Center Experience at Arkansas Children’s Hospital

“…An extensive review of ongoing clinical pharmacogenomics implementation programs at various hospitals and institutions highlighted several adoption and implementation barriers for us to overcome, including scientific, information technology (IT), lack of education of clinical staff and patients, test reimbursement, PGx clinical decision support (CDS), lack of clinician adoption, and data storage for clinical research [ 12 , 39 , 40 , 41 , 42 ].…”

Applying Next-Generation Sequencing Platforms for Pharmacogenomic Testing in Clinical Practice

“…A gene continuum activity score system has been introduced to deal with such situations and may be accepted by reference laboratories and medical centers for converting the genotype data to the clinically actionable recommendations ( Hicks et al, 2014 ). However, to facilitate the incorporation of the high throughput derived PGx reports in the clinical setting, it is necessary to provide the healthcare professionals with more applicable, evidence-based results and employ standardized and updated cohort and case reports ( Giri et al, 2019 ; Krebs and Milani, 2019 ).…”

Development and Implementation of In-House Pharmacogenomic Testing Program at a Major Academic Health System

“…There is no single or dominant model for implementing PGx testing at a healthcare organization ( Giri et al, 2019 ). A key decision for any healthcare organization seeking to implement a PGx program is whether to develop an in-house testing workflow or use the services of a reference laboratory.…”